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Robotics and automation technology (RAT) has emerged as one of the most important drivers of the Industry 4.0 digital transformation of industrial operations. Although RAT has been explored...

The management of MSW is a major concern in several cities of developing countries due to its public health and environmental sustainability implications. This paper thus presents an overview of the current solid waste management practices and problems in some selected states in Nigeria. In addition to the comprehensive review of MSW generation, its characterization, collection, and treatment options in the considered states, an attempt was made to evaluate the major waste–to–energy indicators such as calorific values and energy (electricity) recovery potential. The legislations in place at the federal level to maintain healthy environment is also lucidly presented. An estimated electricity recovery potential in the range of 48.31 to 933.69 MW with a total of about 2600MW from six states was established. Evidences from literature suggested that the existing solid waste management system is inefficient due to uncoordinated and properly planned waste management system. This paper concludes that the thermochemical conversion of waste-to-energy into electricity is a feasible option in Nigeria, although this might require the input of additional quantity of fuel to initiate combustion since the lower heating values of the considered MSW fall below the optimum stipulated by World bank.

In recent decades, technological advancements have led to the introduction of wearable computing devices allowing visualization using virtual, augmented, and mixed reality. The Architecture, Engineering, and Construction industry has seen an increase in the use of such wearable technology, especially with the introduction of information modeling. Building Information Modeling (BIM) has been used extensively on vertical construction projects to better communicate information among project stakeholders and facilitate the construction process. More recently, infrastructure projects started using information modeling along with Geographic Information Systems (GIS) on local or cloud services. The integration of GIS and BIM has the potential to improve the construction process and aid in decision-making, especially when combined with newer visualization techniques. This paper presents a platform for GIS and BIM integration in Mixed Reality. The proposed application will allow a seamless transfer of data from BIM and GIS software into game engines, and the visualization of the BIM-GIS integration on Microsoft HoloLens 2. The application will allow users not only to visualize models, but to explore information in model elements, and make model changes in the mixed reality environment.

LGBTQ + persons experience significant health inequities and medical distrust resulting from anti-LGBTQ + bias or cultural incompetence from health care workers (HCW). This program evaluation examined whether storytelling events where LGBTQ + persons shared personal and patient experiences changed HCW understanding, beliefs, and practices related to LGBTQ + patients. Five storytelling events, held biannually in Baltimore, Maryland from 2016 to 2018, were evaluated using post-event surveys, written reflections/notes during the event, and a survey of HCW in a citywide care collaborative focused on HIV prevention and treatment for LGBTQ + persons that did and did not attend a storytelling event. We analyzed surveys to measure differences in understanding, beliefs and practices and used thematic qualitative analysis of written reflections/notes from the storytelling events. 416 persons attended storytelling events; 124(30 %) completed post-event surveys and 449 written reflections/notes were collected. 56 HCW completed post-event surveys; 49(87.5 %) strongly agreed/agreed they better understood LGBTQ + patients. Emergent themes from the 43 HCW written reflections/notes included improved understanding and new approaches for engaging LGBTQ + patients. Among HCW survey respondents (n = 111), attending an event was associated with significant differences in beliefs (p = 0.024) and practices (p = 0.000) related to LGBTQ + patients. Storytelling events may serve as effective tools for increasing HCW’s understanding, beliefs and practices. This strategy may ultimately help decrease anti-LGBTQ + bias, reduce medical distrust and lower barriers to HIV prevention/treatment for LGBTQ + persons.

Etiologies of HIV disparities are multifaceted; anti-LGBTQ stigma and social marginalization are contributory factors. A city health department developed a program, #ProjectPresence, exhibiting professional photos of Black LGBTQ persons in public spaces. An academic partner explored the relationship of the program to visibility, anti-LGBTQ stigma and social marginalization of Black LGBTQ persons, i.e. models, directly involved in the program and their perceptions of these relationships more broadly for community members. Brief self-administered surveys and semi-structured, in-depth interviews with #ProjectPresence models (n = 15) were conducted after the program to gather their experiences before, during and after the program. Descriptive analyses of survey responses were conducted using Stata 15.1. Interviews were audio-recorded, transcribed and analyzed in NVivo10 using categorical analysis. Surveys indicated prevalent experiences of enacted stigma (73 %) and perceptions of poor local acceptance of LGBTQ people (53 %). Interviews suggested that the program may have influenced positive individual- and community-level changes by increasing visibility of LGBTQ communities and improving acceptance among non-LGBTQ persons, inspiring personal growth and self-acceptance among models, and providing opportunities to foster new connections among LGBTQ subpopulations. Our findings suggest similar programs may present promising approaches for the reduction of stigma and social marginalization affecting LGBTQ persons and communities.

Background Significant HIV disparities affect LGBTQ+ populations and medical mistrust from experiences of healthcare worker (HCW) stigma is a key barrier to HIV prevention and care. This stigma results from many factors, including lack of HCW understanding of LGBTQ+ experiences. The goal was to determine if storytelling nights, events where LGBTQ+ persons share in-depth, personal accounts of their experiences, increased HCW understanding of LGBTQ+ patients. Methods The study design was a retrospective post-test design with surveys conducted after each of 5 storytelling nights and qualitative data collected via post-it notes during each event. All city residents were encouraged to attend, with marketing focused on the LGBTQ+ community and HCWs that interact with LGBTQ+ patients. The survey measured changes in HCW understanding of LGBTQ+ patients as a result of the event. Post-it notes measured HCW reactions to LGBTQ+ patient experiences shared through the storytelling and were analyzed using thematic analysis. Results 416 individuals attended the storytelling nights (mean 83, SD 12.7 per event) and 56 HCWs completed a survey. 49 (87.5%) strongly agreed or agreed that they could better understand their patients’ feelings and concerns after the event. 449 post-its (mean 90, SD 23.1 per event) were collected and 43 (9.6%) post-its were directly related to HCW reflections on LGBTQ+ patients. Three themes emerged from post-it responses: learning new approaches for working with LGBTQ+ patients through the stories; storytelling nights meeting an educational need for HCWs working with LGBTQ+ patients; and the realization that HCWs should take more time to learn about each patient’s needs. Conclusion Events that encourage sharing of experiences, such as storytelling nights, may serve as an effective tool for increasing understanding by HCWs of LGBTQ+ patients by the sharing of unique experiences of LGBTQ+ persons. This may ultimately help to decrease medical distrust of LGBTQ+ populations and improve sexual health and well-being. Disclosure No significant relationships.

Over the years, information and communication technologies (ICT) have advanced significantly to where their applications in the construction industry have improved the efficiency of projects to a large extent. To continuously thrive in the information and technology-driven industry, it is imperative for construction companies to modify their mode of operations to embrace new technology, methods, and processes to influence the performance and efficiency of construction projects positively. Augmented Reality (AR) as a new and emerging technology generates several opportunities for enhancing traditional methods through the integration of AR technologies in the architecture, engineering, construction, and operations (AECO) industry. However, AR technologies are yet to become prevalent in the AECO industry. While AR has a great potential of impacting the construction process, there has been insufficient research on the identification of specific areas for the integration of AR in all phases of construction projects. The purpose of this paper is to offer construction professionals and researchers an account of the possible implementation of AR technologies in each stage of construction projects. The study provides construction professionals the latest research trends and developments in the application of AR, thus helping in the advancement towards significant implementation in the industry for the improvement of construction processes. The paper describes work performed in different construction stages and presents the potential benefits of AR implementation. Finally, recommendations for future research are discussed.

Background: Recent evidence suggests that general anesthetics activate endogenous sleep pathways, yet this mechanism cannot explain the entirety of general anesthesia. General anesthetics could disrupt synaptic release processes, as previous work in Caenorhabditis elegans and in vitro cell preparations suggested a role for the soluble NSF attachment protein receptor protein, syntaxin1A, in mediating resistance to several general anesthetics. The authors questioned whether the syntaxin1A-mediated effects found in these reductionist systems reflected a common anesthetic mechanism distinct from sleep-related processes. Methods: Using the fruit fly model, Drosophila melanogaster, the authors investigated the relevance of syntaxin1A manipulations to general anesthesia. The authors used different behavioral and electrophysiological endpoints to test the effect of syntaxin1A mutations on sensitivity to isoflurane. Results: The authors found two syntaxin1A mutations that confer opposite general anesthesia phenotypes: syxH3-C, a 14-amino acid deletion mutant, is resistant to isoflurane (n = 40 flies), and syxKARRAA, a strain with two amino acid substitutions, is hypersensitive to the drug (n = 40 flies). Crucially, these opposing effects are maintained across different behavioral endpoints and life stages. The authors determined the isoflurane sensitivity of syxH3-C at the larval neuromuscular junction to assess effects on synaptic release. The authors find that although isoflurane slightly attenuates synaptic release in wild-type animals (n = 8), syxH3-C preserves synaptic release in the presence of isoflurane (n = 8). Conclusion: The study results are evidence that volatile general anesthetics target synaptic release mechanisms; in addition to first activating sleep pathways, a major consequence of these drugs may be to decrease the efficacy of neurotransmission.

The future of the construction industry is highly dependent on the competence of new employees. Therefore, it is very important for new employees to enter the industry with the abilities required to resolve the intricate complications inherent in the construction process. However, inadequate exposure of Construction Management students to in-situ construction processes and procedures can be detrimental to their early success and ability to effectively solve problems. In this regard, students often lack comprehension of the complex spatial and temporal constraints which exist during the construction process, thus limiting their productivity. The goal of this study is to determine the value of advanced construction technologies for improving spatial-temporal comprehension of construction processes in construction management students. This study uses Augmented Reality (AR) and a layer of computer visualizations to simulate and enhance the environmental context and spatio-temporal constraints of steel structure erection to determine if learners are able to better comprehend the elements and hidden processes which exist during construction. The positive effects of AR are demonstrated in this study, warranting future research and consideration for construction management education.

There is increasing evidence that cerebral palsy (CP) in developed countries results mainly from antenatal factors, whereas reports from developing countries suggest that perinatal and postnatal factors may be more important because of less than optimal delivery conditions. The authors studied 103 Saudi children with CP and compared their antecedent factors with those of a control group. The major risk factors identified were a history of CP in a sibling and consanguinity of the parents. Low birthweight (less than 2000g), gestational age less than 32 weeks, twin pregnancy and respiratory distress were significantly more frequent among CP cases than controls. The results suggest that antenatal factors, including inherited ones, play a major role in the pathogenesis of CP in Saudi Arabia, which is contrary to previous reports from this region. Their contribution to the pathogenesis of CP in developing countries may be greater than previously assumed.

SUMMARY The electroencephalograms (eegs) of 96 Nigerian epileptic children up to 10 years of age were reviewed. All had been seen at University College Hospital, Ibadan, between 1970 and 1973. Eight per cent suffered from centrencephalic epilepsy, of whom one-half suffered from petit mal epilepy. eeg focus of temporal lobe epilepsy was the most common finding (36 per cent) in those children with focal epilepsy. There was little correlation between the clinical type of epilepsy and the eeg findings. The relatively low frequency of petit mal epilepsy in Africans reported by other authors is confirmed by the present report. RESUME Les electroencephalographies (eeg) de 96 enfants Nigeriens, ages de 10 ans ou plus, epileptiques, examines a l'Universite College Hospital, d'Ibadan, Nigeria, durant la periode 1970–1973, sont analysees. 8 pour cent presentaient une epilepsie centre-encephalique, parmi lesquels 4 pour cent avaient un petit mal epileptique. Les eeg d'epilepsie temporale localisee constituaient le cas le plus frequent (36 pour cent) d'epilepsie focale. Peu ou pas de correlations ont ete notees entre le type clinique de l'epilepsie et les decouvertes d'electro. L'article present confirme donc la frequence relativement faible du petit mal chez les Africains soulignee par d'autres auteurs. ZUSAMMENFASSUNG Es wurden die Elektroencephalogramme (eegs) von 96 Kindern aus Nigeria, die an einer Epilepsie litten und zehn Jahre oder junger waren, beurteilt. Diese Kinder wurden in den Jahren von 1970 bis 1973 am University College Hospital von Ibadan, Nigeria untersucht. 8 Prozent hatten eine centrencephale Epilepsie, davon 4 Prozent eine Petit-Mal-Epilepsie. Bei den Kindern mit Temporallappenepilepsie war der haufigste Befund (36 Prozent) ein eeg-Focus bei Temporallappenepilepsie. Die Korrelation zwischen dem klinischen Typ der Epilepsie und den eeg Befunden war nur gering oder fehlte. Die vorliegende Arbeit bestatigt die relativ niedrige Frequenz der Petit-Mal-Epilepsie bei Afrikanern, wie von anderen Autoren berichtet wurde. RESUMEN Se revisan los eeg de 96 ninos nigerianos de 10 anos de edad y mas jovenes con epilepsia y que habian sido vistos en el Hospital del Colegio Universitario de Ibadan en Nigeria, en el periodo de 1970 a 1973. Ocho por ciento padecian una epilepsia eentroeneefalica, y de ellos el 4 por ciento tenian una epilepsia tipo petit mal. El foco eeg de epilepsia temporal fue el hallazgo mas corriente (36 por ciento), en los ninos con epilepsia focal. No habia correlacion o solo muy pequena entre el tipo clinico de epilepsia y los hallazgos del eeg. La comunicacion presente confirma la relativamente baja frecuencia de la epilepsia con petit mal en africanos, ya citada por otros autores.

The prevalence of migraine and tension headache was determined in a 2-stage, door-to-door community survey in Thugbah, Saudi Arabia. Out of 22630 subjects surveyed, 2742 individuals had headaches thus yielding a crude prevalence of 12.1% (95% CI = 11.7–12.5%) and with age-adjustment, it rose to 15.9% (95% CI = 15.4–16.4%). There was female preponderance overall and the peak frequency was in the 3rd decade. The age-specific rates rose from 2.4% in the first decade to 37.2% in the 7th decade. The prevalence of tension-type headache (PR 9.5%; 95% CI = 9.1–9.9%) was higher than migraine (PR = 5.0%; 95% CI = 4.7-5.3%). The low headache prevalence in this community compared to findings in western countries could be ascribed to the young age of the population and/or could possibly reflect the influence of traditional life styles and cultural factors in the Kingdom.

Epidemiological studies have shown a consistent downward trend in the incidence and mortality of stroke in industrialized communities. There are however no reports on the pattern of stroke in Saudi nationals and expatriates in Saudi Arabia. The types and etiologies in 372 subjects (262 Saudis, 110 non-Saudis) are described. Males outnumbered females in the ratios of 2.2:1 and 8.2:1 for Saudis and non-Saudis, respectively. The frequency of stroke increased steadily with age until the 7th decade in Saudis but dropped sharply after the 6th in expatriates. The frequency of stroke types in Saudis was ischemic (61%), hemorrhagic (17%) and unspecified (22%) as against 46, 47, and 7% respectively in non-Saudis. Intracerebral hemorrhage was more frequent than subarachnoid hemorrhage (SAH) and was encountered more often in Saudis than in non-Saudis; SAH was 3 times more common in expatriates than in Saudis. The major predisposing factors for stroke were hypertension, diabetes mellitus, and cardiac disorders. Abnormal hemoglobinopathies, especially sickle cell anemia, were rare. The differences observed in the age and sex distribution and in the stroke pattern between Saudi nationals and expatriates most likely reflect the demographic structure existing in Saudi Arabia.

SYNOPSIS The pattern of headache syndromes in 222 subjects (142 Saudi nationals, 80 non-Saudis) seen at AI-Khobar, Saudi Arabia is presented. Headaches were common, and accounted for 13% of all neurological outpatients. They affected mainly young adults, with a peak frequency in the third decade for Saudis and the fourth for non-Saudis. They were rare in those under 10 and above 50 years old. Among Saudis, females outnumbered males especially in the second and fifth decades, while non-Saudi males were more frequent than females in all age groups except the second decade. The main types were tension headache (66%) and migraine (22%). Acute/chronic sinusitis was an uncommon cause of headache. Tension headache affected mainly individuals between 21 and 40 years of age (69%). It showed a female preponderance in Saudis aged 11-20 and above 40 years, unlike the male predilection in non-Saudis. Migraine showed a definite female predilection only in Saudis in the fourth decade (female to male ratio of 4:1 ). A positive family history for headache was present in 10% of the cases. The major precipitating factor for headaches was stress related to family or working conditions. Other triggers included hunger and prolonged exposure to excessive heat or sunlight. The pattern of headaches in Saudi nationals may be related to the prevalent sociocultural factors, and the differences observed between them and non-Saudis probably reflect the demographic status of non-Saudis in the Kingdom as a consequence of governmental recruitment policy.

Purpose: To determine the prevalence of epilepsy and other convulsive disorders and the causes of symptomatic epilepsies in a Saudi Arabian population. Methods: Door to door survey of a restricted area inhabited by 23 700 Saudi nationals. The World Health Organization (WHO) protocol designed to detect neurological disorders was used as screening instrument. All patients with probable seizures were examined by a neurologist and 92% of positive cases were investigated by brain computed tomography (CT) and electroencephalogram (EEG). Results: Prevalence rate (PR) for active epilepsy was 6.54 /1000 population (95% confidence interval 5.48–7.60). Twenty-eight percent of the patients had partial seizures, 21% generalized seizures and in 51%, it was not possible to determine if the generalized seizures had focal onset or not. The epilepsy was symptomatic in 32% of the cases: pre or perinatal encephalopathy 23%, head injury 4%, childhood neurological infection 4% and stroke 1%. Febrile convulsions PR was 3.55 /1000 children under the age of 6 years and isolated seizures were documented in only 0.18 /1000 population. Conclusions: The PR of epilepsy in Saudi Arabs is within the range of the values reported in most communities. The causes of symptomatic epilepsies revealed a predominance of perinatal and inherited factors. Isolated and non-convulsive seizures were probably under-recognized due to various social and cultural factors as well as to lack of sensitivity of the questionnaire for non-convulsive seizures.

This study reports the clinical features and neuroimaging correlates of stroke in Saudi children seen over a 5-year period at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. During the study period, 31 (18 boys, 13 girls; mean age, 26.2 months) of the 20,895 children seen had stroke; the annual stroke incidence was 29.7 per 100,000 in the pediatric population. Ischemic strokes accounted for 90% and hemorrhagic 10% of the cases, respectively. The boys-to-girls ratio for ischemic stroke was 2:1. Cranial computed tomographic scans and magnetic resonance imaging findings were abnormal in 82% and 91%, respectively. The etiologic factor was undetermined in 65% of the cases. Our results suggest that stroke is uncommon in Saudi children. However, further studies evaluating a larger population in different clinical settings are required to provide a more comprehensive picture of stroke in children in this area. (J Child Neurol 1999;14:295-298).

A stroke registry was established in the Eastern Province of Saudi Arabia with an estimated population of 750,000 inhabitants of whom 545,000 are Saudi citizens. The register started in July 1989 and ended in July 1993. The Gulf war led to its interruption from August 1990 to August 1991. Four hundred eighty-eight cases (314 males, 174 females) of first-ever strokes affecting Saudi nationals were registered over the 3-year period. The crude incidence rate for first-ever strokes was 29.8/100,000/year (95% CI: 25.2–34.3/100,000 year). When standardized to the 1976 US population, it rose up to 125.8/100,000/year. Ischemic strokes (69%) predominated as in other studies but subarachnoid hemorrhage (SAH) was extremely rare (1.4%). The important risk factors were: systemic hypertension (38%), diabetes mellitus (37%), heart disease (27%), smoking (19%) and family history of stroke (14%). Previous transient ischemic attacks (3%) and carotid bruits (1%) were uncommon. The 30-day case fatality rate was 15%. The study showed that the age-adjusted stroke incidence rate for Saudis in this region is lower than the rates reported in developed countries but within the range reported worldwide. The pattern of stroke in Saudi Arabia is not different from that reported in other communities with the exception of the low incidence of SAH. The risk factors are similar to findings in other studies except for the high frequency of diabetes mellitus in our cases. The lower mortality rate was probably due to the younger age of the population and the availability of free medical services for management of cases.

A pilot study of the Agrabiah area in Al-Khobar was undertaken to field test study methodologies and identify possible limitations and constraints to a planned community survey for neurological disorders in the Eastern Province of Saudi Arabia. The survey used a pre-tested questionnaire administered by trained personnel to all subjects living within 50 blocks randomly selected from the 198 inhabited ones in the area. Subjects with abnormal responses on screening were then evaluated by neurologists using specific guidelines and criteria to establish the diagnosis of neurological disease. One thousand four hundred and eighty-five subjects (98.3% of all eligible subjects) were screened: 227 (15%) had abnormal responses. Of the 202 subsequently evaluated by neurologists, 178 had definite neurological disease. The overall crude prevalence rate (PR) per 1000 population for neurological morbidity was 120.5 (95% confidence limits [CL] 103.5 to 136.5). Headache syndromes (PR 99.7, CL 83 to 114.7) were common. The other common disorders were seizures (PR 10.2, CL 5.1 to 15.3), peripheral nerve disorders (PR 2.7), and stroke (PR 2.0). Mental retardation and cerebral palsy were the main pediatric problems with PRs of 1.4 and 0.7 respectively. Our results show that a community survey for neurological disorders is feasible in Saudi Arabia and the modified questionnaire was a good screening instrument (sensitivity 94.7%, specificity 96.8%). However, the findings on the pattern and prevalence of neurological disorders need to be viewed with caution, particularly against the background of the scope of the study and the small number of subjects assessed. Cultural practices, local time and social events, and climatic conditions significantly affected community participation and the coverage achieved by the study. These factors should be considered when planning community surveys in Saudi Arabia and other environments with similar sociocultural settings.

The patterns of degenerative ataxias as seen over a six year period at the King Fahad Hospital of the University, Al Khobar in the Eastern Province of Saudi Arabia are reported. Twenty two cases were seen, giving a hospital frequency of 7/100,000 patients. Early onset ataxias were the most common, particularly Friedreich disease (9/22). Uncommon types such as ataxia with hypogonadotropic hypogonadism and ataxia with oculomotor apraxia were encountered. There were six late onset ataxias: "pure cerebellar" ataxias were the most common. These data are discussed and compared with other reports, keeping in mind that these disorders are evelotive and their nosologic patterns can change with their progression.

We report the findings of a total population survey of Thugbah community in the Eastern Province of Saudi Arabia (SA) to determine its point prevalence of neurological diseases. During this two-phase door-to-door study, all Saudi nationals living in Thugbah were first screened by trained interviewers using a pretested questionnaire (sensitivity 98%, specificity 89%) administered at a face-to-face interview. Individuals with abnormal responses were then evaluated by a neurologist using specific guidelines and defined diagnostic criteria to document neurological disease. The questionnaire was readministered blind by a neurologist to all those with abnormal responses and a 1-in-20 random sample of those without abnormal responses, respectively. The family members of an individual with an abnormal response were also screened to improve accuracy. A total of 23,227 Saudis (98% of the eligible subjects) were screened and those residing in Thugbah on the reference date (22,630) were used to calculate the point prevalence rates. Forty-two percent of those screened were in the first decade of life and only 1.5% were more than 60 years old. There were marginally more females (50.2%) than males (49.8%). Consanguineous marriages especially between first cousins were present in 54.6%. The demographic characteristics of Thugbah community were similar to those in other parts of SA. The overall crude prevalence ratio (PR) for all forms of neurological disease was 131/1,000 population. All subsequent PRs are per 1,000 population. Headache syndromes were the most prevalent disorder (PR 20.7). The PR for all seizure disorders was 7.60, and the epilepsies (6.54) were more frequent than febrile convulsions (0.84). Mental retardation, cerebral palsy syndrome, and microcephaly were common pediatric problems with PRs of 6.27, 5.30 and 1.99, respectively. Stroke, Parkinson's disease, and Alzheimer's disease were uncommon with respective PRs of 1.8, 0.27 and 0.22. Central nervous system (CNS) malformations (0.49) such as hydrocephalus and meningomyelocele were more prevalent than spinal muscular atrophy (0.13), congenital brachial palsy (0.13) and narcolepsy (0.04). Multiple sclerosis was rare (0.04). Osteoarthritis and low back pain syndromes were the main non-neurological conditions seen. The major medical diseases that may be neurologically relevant were diabetes mellitus, hypertension, and connective tissue disorders.(ABSTRACT TRUNCATED AT 400 WORDS)

We describe the clinical features of 25 cases of Werdnig Hoffman's disease (spinal muscular atrophy (SMA) type I) seen propectively over a two-year period at the King Fahd Hospital of the University (KFHU), Al-Khobar. The hospital incidence rate was 1.93 per 1,000 live births (95% confidence limits, 0.80-3.06/1,000). The estimated prevalence rate for the community was 0.92/10,000 with 0.59-1.25 per 10,000 children as its 95% confidence limits. The male to female ratio was 2:3. Reduced fetal movements were reported by six mothers; 8 children (32%) had symptoms at birth, and 24 (96%) had symptoms by the time they were six months old. Other features apart from hypotonia, muscle weakness, and absent deep tendon reflexes included head lag with inability to achive head control at six months (88%), respiratory problems consisting of difficulty with breathing or frequent chest infections (44%), and difficulty with feeding (40%). Wasting with fisciculations of the tongue was seen in 64%. Death occurred within six months of presentation in 75% of the cases. The parents were consanguineous in 64% of the cases. This high consanguinity rate was probably the major cause for the high population prevalence rate.

We report our observations in 427 stroke patients (305 Saudis, 122 non-Saudis with an age range of 14 months to 85 years) seen in a tertiary hospital in the eastern province of Saudi Arabia over an 8-year period. Of these patients, 115 (27%) were between 18 and 45 years old, and constituted the "young stroke patients" for this study. The hospital frequency for the young was 5/10,000 inpatients. In general, there was a male preponderance, with a male:female ratio of 2.2:1 and 7:1 for Saudis and non-Saudis, respectively. Ischemic stroke (55%) was more frequent than hemorrhagic stroke (25%), and the stroke was unspecified in 20%. The main etiologic factors were hypertension, diabetes mellitus and cardiac disorders. In the young population, the frequencies of hemorrhagic and ischemic strokes were similar. In this group, the main causes of intracerebral hemorrhage were aneurysms and arteriovenous malformations, while arteriosclerosis and embolism of cardiac origin were responsible for the ischemic strokes. In Saudis, the stroke types were 59% ischemic, and 17% hemorrhagic, as against 45 and 48% in non-Saudis, respectively. Most ischemic strokes were found in Saudis (78%). Intracerebral hemorrhage accounted for 63% of all hemorrhagic strokes, and was more frequent in Saudis but subarachnoid hemorrhage was three times more common in non-Saudis. In the young stroke patients, interethnic comparison showed that individuals from the Far East were nine times more likely to have hemorrhagic than ischemic stroke compared to the others (odd's ratio = 8.7), and the etiology of ischemic stroke remained undetermined in 67% of those from the Indian subcontinent.(ABSTRACT TRUNCATED AT 250 WORDS)

The pattern of epilepsy and other convulsive disorders in 1,000 consecutive Saudi nationals is described. These disorders were common with a hospital frequency rate of 8 per 1,000. Men were more frequently affected than women and 60% of the patients were under 10 years old at the onset of their illness. The epilepsies were the commonest type (74%). Febrile convulsions (20%) presented mainly between the ages of one and five years. Isolated seizures (3%) and acute symptomatic convulsions (3%) were uncommon. In the epileptic group, generalised seizures (71%) were more frequent than partial (29%) and complex partial seizures occurred mainly in those above 21 years old. Absences (4%), infantile spasms (3%) and atonic seizures (3%) were uncommon. No specific etiology of the epilepsy was determined in the majority of the cases (63%). The identified major etiologic factors of the epilepsies were perinatal encephalopathy (21%), cerebral trauma (11%), sequelae of meningitis or encephalitis (2%), brain tumors (0.5%), and vascular lesions such as stroke and arteriovenous malformation. Perinatal encephalopathy accounted for 40% of the epilepsies in children less than 5 years old, and trauma for 20% of those above 20 years old. A family history of epilepsy in close relations was obtained in 23% of the cases, and the consanguinity rate among the parents was 53%. The high incidence of associated perinatal encephalopathy found in this study suggests that perinatal factors play a major role in the pathogenesis of epilepsy in Saudi Arabia. The high frequency of cerebral trauma was also striking. Although consanguinity of the parents appeared not to be a major factor in the genetics of convulsive disorders in this environment, it might have potentiated the tendency of familial aggregation of convulsive disorders in this community. Consanguinity may be an important factor in the production of some of these disorders but its precise role has not been determined.

The results of a prospective study of 34 Nigerian women with obstetric neuropraxia (puerperal paresis of the lower limbs) seen at the University College Hospital, Ibadan, are presented. The height of 29 (84%) was under 62 in (1.58 m). All were younger than 45, and 41% (14) were primiparous. Lumbosacral plexus injury with a foot-drop was the most frequent presenting feature (88%), bilateral involvement was observed in 13 patients (38%), femoral neuropathy was observed in nine (26%) and the ankle tendon jerks were absent in 35%. Spastic paraparesis was not uncommon (15%). Results of electromyographic examination and determinations of conduction velocities were consistent with proximal neuropraxia of the lumbasacral trunk in many of them (88%). The presentation of the fetus was cephalic in 97% of the women. The major predisposing factor was prolonged labor. Among the complications associated with the neuropraxia were hydroureters above the pelvic brim and vesico- and rectovaginal fistulae. Perinatal mortality was high particularly with labor of more than 18 hours. Recovery from the neuropraxia was complete for 76% of the patients. It is concluded that direct pressure on the lumbosacral plexus and nerve trunks by the presenting fetal part is the major factor in the pathogenesis of obstetric neuropraxia encountered in Nigerians.

Because of the scarcity of trained personnel in neurology in developing countries, we designed a protocol utilizing, in large part, non-doctor primary health care personnel for collecting data in a do

SIX patients with G6PD deficiency who presented in hospital with haemoglobinuria and haemolytic anaemia are reported. The haemolytic process was precipitated by naphthalene in three cases, aspirin in one, maloprim in one, and typhoid fever in one. The clinical course and prognosis are discussed.

In a Nigerian town with a stable population of 20,000, a door-to-door survey was conducted, using a questionnaire involving a complete census and a simple neurological evaluation which had previously showed a 95% sensitivity and an 80% specificity for detecting neurological disease. Positive responders were evaluated and categorised, using agreed criteria for diagnoses. Nearly 100% cooperation was obtained. Life prevalence ratio for at least one episode of headache was 51/1000. Crude point prevalence ratio for migrainous headache was 5.3/100, and peak age-specific ratio was in the first decade. Prevalence ratio for epilepsy was 533/100,000 and peak age-specific prevalence ratio occurred in the 5-14 years age groups. The prevalence ratio for peripheral nerve disorders was 268/100,000, and age-specific prevalence ratio for tropical neuropathy increased with age. Prevalence ratio for stroke was rather low at 58/100,000, but was probably due to the people's attitude to the disabled elderly and high mortality of stroke which showed annual mortality rate of 70/100,000 which increased with age to 1519/100,000 per year in the eighth decade. Crude prevalence ratios (cases per 100,000) for others are 112 for neurological complications (including sciatica) of spondylosis, 15 each for poliomyelitis, motor neurone disease, development speech disorders, 10 each for syncope, hereditary neuropathies. Parkinson's disease, benign essential tremor, primary cerebellar degeneration, cerebral palsy, mental retardation, organic psychosis (probable intracranial tumor) and 5 each for muscular dystrophy, pyomyositis, spina bifida occulta, alcohol dependence and cerebral malaria. The implications of the findings are important for development of community neurological services in the developing countries.

Factors determining prognosis in tetanus have been based mainly on clinical grounds and mortality is high especially in the developing countries. The biochemical changes occurring in tetanus before any form of therapy or sedation, were examined to determine screening parameters for earlier institution of intensive care in high risk patients. The results obtained from a prospective study of 73 patients are presented. The blood sugar and serum transaminases correlated well with the severity of the disease. The serum glutamic oxalate transaminase and blood urea were significantly higher in fatal cases. These findings as well as the clinical criteria utilized in determining the severity of the disease in this study are useful in predicting the outcome of the disease. It is suggested that these simple investigations could serve as screening parameters for instituting early intensive care in tetanus.

As part of a pilot study to determine the feasibility of a survey to detect major neurologic diseases among rural populations in developing countries, it was possible to obtain data on the prevalence of migraine in a rural Nigerian population. Using defined diagnostic criteria, a neurologist identified 62 individuals among a group of 903 as having migraine, yielding a point prevalence ratio of 69/1,000. The prevalence among females was approximately twice the figure for males. In 80%, a first-degree relative suffered from ''similar headaches''. Above age 39, the age-specific prevalence ratio declined with increasing age. The relative risk of epilepsy in those with migraine was 3. The high prevalence of migraine, comparable to reported data from Caucasian populations in developed countries, is surprising.

Thirty-eight percent of patients with infective endocarditis (36 of 95) had neuropsychiatric manifestations. In 75% (27 of 36), these features were the major presenting picture. Fifteen patients (42%) presented with cerebrovascular lesions and seven (19%) with meningitis. Toxic encephalopathy (12.5%) was not uncommon. Other neurological syndromes seen included psychosis and spinal cord lesions. The mortality was high especially when the infective endocarditis was acute in onset. It is essential to search diligently for an underlying cardiac cause in patients who present with neuropsychiatric symptoms because treatment of the underlying pathology improves prognosis.

Assessment of nutritional status of vitamin B components by plasma or blood levels indicated riboflavin deficiency and possibly thiamine deficiency in Nigerian patients who suffered from tropical ataxic neuropathy and neurologically normal Nigerians who subsisted on predominant cassava diet. Serum levels of folate, niacin, pyridoxine and panthothenic acid were normal. Vitamin deficiencies probably are minor factors, if any, in the pathogenesis of tropical ataxic neuropathy in Nigerians.

A door-to-door survey of Parkinson's disease (PD) in Copiah County, Mississippi, using a pretested screening procedure (with a high sensitivity for detecting PD), followed by examination of all positives by a senior neurologist, revealed similar prevalence ratios for blacks and whites. The same procedure was applied in the community of Igbo-Ora, Nigeria, a black population of West Africa. To assure uniformity in the procedures and application of the diagnostic criteria, a neurologist from each survey site visited the other site. Among a black population of 3,521 over age 39 in Copiah County, there were 12 cases of PD, with an age-adjusted prevalence ratio of 341/100,000. The comparable figures for Igbo-Ora were as follows: population over age 39 = 3,412; cases of PD = 2; age-adjusted prevalence ratio = 67/100,000.

In a case-control study we compared 155 Nigerians affected by epilepsy, with an equal number of controls matched for age and sex, with the aim of identifying risk factors of epilepsy. Febrile convulsions and head trauma (with odds ratios of 11.0 and 13.0, respectively) were significant risk factors (p less than 0.01). Childhood immunizations were found associated with a decreased risk of epilepsy. None of the following factors was significantly associated with epilepsy: hemoglobinopathy, venereal disease, use of psychotropic drugs or alcohol, and cerebrovascular disease. Preventive measures for the risk factors identified are suggested as ways of reducing the burden of epilepsy in Nigeria.

Two cases of Waldenstrom's macroglobulinaemia have been seen at University College Hospital, Ibadan in the last four years, Case 1 was a 30-year-old soldier who presented with splenomegaly and anaemia, was treated with chlorambucil, and had a complete remission sustained for over two years. Case 2 was a 58-year-old retired civil servant who presented with very severe anaemia and also splenomegaly, and died within three weeks of admission. Both patients had most of the typical features of Waldenstrom's disease, including retinal changes and serum IgM levels of 4200 and 5500 mg/dl respectively. In both cases an atypical cold antibody was detected in the course of blood cross-matching procedures. In case 1, the antibody agglutinated all adult and cord red cells tested, including the patient's own cells, to a titre of 8000 and above at 4 degrees C. Suprisingly enough, when the patient went into remission and the serum IgM level had fallen to 400 mg/dl, this antibody was no longer detectable and has not reappeared two years later. In case 2, the antibody agglutinated all adult red cells tested to a titre of 2000 at 20 degrees C but not the patient's own red cells. Since cord cells were agglutinated only to a titre of 4 to 20 degrees C it was concluded that the patient had an alloantibody with I-specificity. Therefore in both these patients the monoclonal immunoglobulin produced by the neoplastic lymphoid cell clone had specific activity against red cell antigens.

Studies based on hospital populations reported from negro communities in several countries in Africa suggest that cerebrovascular disease (CBVD) shows increasing mortality and morbidity in Africans although 2 decades ago CBVD was believed to be uncommon. We report the first study in the African to determine the incidence of stroke in an urban area, Ibadan, Nigeria.

The neurospsychiatric manifestations of typhoid fever in 959 Nigerian patients included confusional states or delirium (57%), semicoma (2.6%), coma (1.0%), meningism (5%), meningitis (0.2%), convulsions (1.7%), generalized myoclonus (0.5%), focal neurological deficit— deafness, hemiplegia, infranuclear facial palsy— (0.5%), transient or evanescent parkinsonism (1.0%), symmetrical, usually transient, spasticity of all limbs (3.1%), and generalized hypotonicity (0.2%). Seven patients had symmetrical sensorimotor polyneuropathy without cytoalbuminological dissociation in cerebrospinal fluid, and three patients had a mononeuritis. One young man developed motor neuron disease two months after recovering from typhoid fever. In five patients (0.5%), the initial diagnosis was schizophrenia. Two developed schizophrenic psychoses, and two other patients suffered from temporary amnesia during convalescence.

Of 2.1 million patients seen in 25 years at the University College Hospital, Ibadan, Nigeria, only 25 suffered from heredodegenerative disorders of the nervous system. Six patients had hereditary ataxia, 10 essential tremor, 4 Huntington's chorea, 2 ataxia telangiectasia, and 3 Charcot-Marie-Tooth disease.